The Effect Of Critical Illness Insurance On The Mental Health Of Middle-Aged And Elderly People

BackgroundIn the context of aging,health issues of middle-aged and elderly people have become a hot topic of social concern.They not only have a decline in physiological function,but also has a significant impact on their mental health.Depression is an effective indicator for measuring the mental health.The influencing factors of depression of middle-aged and older people include poor sleep quality,social isolation,etc.,especially physical health status.Due to the uncertainty of diseases,concerns about illness and the economy can affect their mental health status.Health insurance,as a formal form of social support,can reduce the economic risks and diseases risks when people seeking medical treatment through the cost compensation mechanism provided by the fund of insurance.In 2015,China launched the critical illness insurance for urban and rural residents,providing additional economic security to reduce the economic burden of diseases on the population.This policy provides a quasi-natural experiment to identify the role of health insurance in mental health.ObjectiveThis study explores the impact of critical illness insurance on the mental health of middle-aged and elderly people,as well as the heterogeneity of policy effects on different groups.It provides policy optimization suggestions for health insurance system to fully play the role of promoting the physical and mental health of middle-aged and elderly people.MethodsThe study used data from the four waves of panel data in the China Health and Retirement Longitudinal Study(CHARLS:2011,2013,2015 and 2018).This study used the total scores of the CESD-10 Depression Scale as a proxy variable for the mental health.Our treatment variable was defined as ’whether the individual i was in the city where critical illness insurance was implemented or not by year t’,expressed as 1 if individual i was in the city where critical illness insurance was implemented by year t and 0 otherwise.The specific implementation time of critical illness insurance in various cities obtained through official websites and telephone consultations and then matched it with the CHARLS database.This study used STATA14.0 for data analysis.Based on the fixed effects model determined by Hausman test,we used time-varying difference-in-difference model(time-varying DID Model)and time-varying DID Model after propensity score matching to measure the impact of critical illness insurance on depression in middle-aged and elderly people.Heterogeneity analysis is also conducted on the policy response of households with different consumption levels,whether they suffer from chronic diseases,and populations with different self-rated health.ResultsThe results of time-varying DID model and time-varying DID model after propensity score matching showed that critical illness insurance can significantly reduce the total scores of depression of middle-aged and elderly people.The results of heterogeneity analysis showed that critical illness insurance can reduce the total scores of depression among households with moderate and low consumption levels(moderate:Coefficient:-0.7538,P<0.01;low:Coefficient:-0.7273,P<0.001),while the result was not significant for individuals in households with high consumption levels.Critical illness insurance can reduce the depression scores among individuals suffered from chronic diseases(Coefficient:-0.4736,P<0.001),but the result was not significant for individuals without chronic diseases.Critical illness insurance can reduce the total scores of depression among individuals with poor self-rated health(Coefficient:-0.5636,P<0.001),but it was not significant on the policy effect of individuals with general and good self-rated health.Conclusions and suggestionsConclusionsThe implementation of critical illness insurance for urban and rural residents has a significant and positive effect on the mental health of middle-aged and elderly people.In addition,critical illness insurance showed greater psychological improvement for individuals with poor self-rated health,chronic diseases and households with low and moderate consumption levels.SuggestionsFirst,reducing the upper limit of out-of-pocket expense of health insurance and expanding the list of medical services.Second,expanding the health insurance coverage and alleviating health inequality.Third,paying attention to vulnerable groups and implementing preferential policies for them in critical illness insurance.Fourth,emphasizing mental health and increasing investment in mental health services.Fifth,strengthening publicity and education to promote the implementation of critical illness insurance in various regions.